A Narrative Review of the Recent 'Ice' Epidemic: An Australian Perspective

'Even though you hate everything that's going on, you know they are safer at home': The role of Aboriginal and Torres Strait Islander families in methamphetamine use harm reduction and their own support needs

Introduction

First Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood.

Methods

We conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms.

Results

Findings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing.

Discussion and Conclusions

First Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives.

"We're supposed to be a family here": An ethnography of preserving, achieving, and performing normality within methamphetamine recovery

The perception of being abnormal, and a visceral desire to ‘feel normal again’, is a common feature of the literature on drug use and recovery. Normality is constructed, however, in response to context-dependent values and priorities, thereby legitimating certain behaviours as normative and therefore the assumed goal of people in recovery. In this paper we draw on an ethnographic study with twelve people attempting to reduce harmful methamphetamine use to explore how they engaged with ‘normality’. Semi-structured interviews and ethnographic observations were conducted across a range of settings related to participants’ recovery, including private residences, withdrawal services, doctor’s offices, counselling rooms, and court houses. We used a relational lens to conduct thematic analysis on interview transcripts and fieldnotes collected over six months, following the steps of Iterative Categorisation. Our analysis explores the central organising theme of normality as something that can be ‘preserved’, ‘achieved’, or ‘performed’ by people using methamphetamine. Findings are understood through the original concept of ‘ambient paternalism’, where neoliberal norms and values shape recovery trajectories even outside of engagement with services. Exhibiting normality enabled participants to work against the stigmatisation and moralisation of methamphetamine use by demonstrating their socio-political acceptability. Methamphetamine use could also be strategically used to enable participants to keep up with neoliberal normative standards of independent self-management. Increasing awareness of these complex repertoires of normality, and a more critical understanding of how this ideal is constructed and can impact service interactions, can support a less homogenising or coercive approach towards treatment and policy for people in methamphetamine recovery.

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People using drugs can experience normality as aspirational and burdensome.

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Demonstrating normality in recovery can be a form of social capital.

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Normality can be a form of paternalism enacted by social services.

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Performing normality helped participants reduce their marginalisation.